The Role of EUS and EUS-FNA in Differentiating Benign and Malignant Gallbladder Lesions

Abstract

Endoscopic ultrasonography (EUS) has greater spatial resolution than other diagnostic imaging modalities. In addition, if gallbladder lesions are found and gallbladder cancer is suspected, EUS is an indispensable modality, enabling detailed tests for invasion depth evaluation using the Doppler mode and ultrasound agents. Furthermore, for gallbladder lesions, EUS fine-needle aspiration (EUS-FNA) can be used to differentiate benign and malignant forms of conditions, such as xanthogranulomatous cholecystitis, and collect evidence before chemotherapy. EUS-FNA is also useful for highly precise and specific diagnoses. However, the prevention of bile leakage, an accidental symptom, is highly important. Advancements in next-generation sequencing (NGS) technologies facilitate the application of multiple parallel sequencing to EUS-FNA samples. Several biomarkers are expected to stratify treatment for gallbladder cancer; however, NGS can unveil potential predictive genomic biomarkers for the treatment response. It is believed that NGS may be feasible with samples obtained using EUS-FNA, further increasing the demand for EUS-FNA.

Precursor Lesions of Gallbladder Carcinoma: Disease Concept, Pathology, and Genetics

“…Acknowledging the pathology of precursor neoplastic lesions of the gallbladder is extremely important not only for pathologists but also radiologists, physicians, and surgeons. Although EUS-FNA for diagnosing gallbladder lesions has not been widely used, the demand for the procedure is increasing not only for gallbladder lesions with wall thickening but also for gallbladder polyps [ 67 , 68 , 69 ].…”

The Double-Max method: a novel method for gallbladder epithelial biopsy

“…Despite advancements in imaging technology, it is still difficult to distinguish benign from malignant gallbladder lesions. 2 In the case of suspected malignancy, an Figure 1. Images of the gallbladder lesion.…”

The usefulness of endoscopic ultrasound in the diagnosis of gallbladder lesions

“…Therefore, they are discovered incidentally during comprehensive health examinations or examinations for other medical purposes. Gallbladder polypoid lesions are classified as neoplastic or non-neoplastic, and epithelial or non-epithelial according to their microscopic structure and invasive characteristics ( 2 ). Polypoid lesions of the gallbladder should be differentiated at early stage gallbladder carcinoma from other benign lesions such as cholesterol polyp, hyperplastic polyp, metaplastic polyp, and inflammatory polyp ( 9 , 10 ).…”

“…EUS is reported to be useful for diagnosing benign and malignant gallbladder lesions and determining the invasion depth of gallbladder cancer ( 1 ). Recently, contrast-enhanced harmonic EUS (CH-EUS), which allows evaluation of blood flow, has enabled a more accurate diagnosis of gallbladder tumors than fundamental B mode EUS (FB-EUS) ( 2 , 3 ). EUS also plays a major role in the histological diagnosis of gallbladder lesions, with EUS-guided fine needle aspiration (EUS-FNA) being reported to be useful for obtaining tissue samples of gallbladder tumor for pathological evaluation ( 4 , 5 ).…”